Pandemic, Civil Unrest, and a Tropical Storm - What Is Next? The Locusts??
Authors: Amedee RG, Malone M PMID: 32612459 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Telehealth: An Important Player During the COVID-19 Pandemic.
Authors: Ali NA, Khoja A PMID: 32612460 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Community Outreach Panel Explores and Addresses Higher Rates of COVID-19-Related Deaths in the African American Population.
Authors: Laborde Y, Manayan O PMID: 32612461 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Hirayama Disease in an Adolescent Male With Right Hand Weakness and Muscle Wasting.
Authors: Llano J, Lall NU, Davis L, Steven AJ PMID: 32612462 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Does Massage Help Athletes After Exercise?
Authors: Sriwongtong M, Goldman J, Kobayashi Y, Gottschalk AW PMID: 32612463 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Global Health Is Local Health: A Multidisciplinary Perspective of COVID-19.
Authors: Hinchman A, Ali D, Goodwin BW, Gillie M, Boudreaux J, Laborde Y PMID: 32612464 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Multiple Fatalities in a Family Cluster of COVID-19 With Acute Respiratory Distress Syndrome.
Conclusion: This report describes a familial cluster of fatal COVID-19 infections and suggests a potential genetic predisposition for severe disease, emphasizing the importance of investigating family clusters of severe COVID-19 infection to determine host and viral factors that may predispose to a severe disease course. Such investigations could improve our understanding of the disease and guide preventive measures for at-risk populations. PMID: 32612465 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Getting Ahead of the Curve: How Ochsner Became a Leader in SARS-CoV-2 Diagnostic Testing.
Authors: Caruso LJ, Chang DD, Hovis KB, Linscott AJ, Goens EF, Yang T, Occhipinti E PMID: 32612466 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Answering the Call: Medical Students Reinforce Health System Frontlines Through Ochsner COVID-19 Hotline.
Authors: Santos JJ, Chang DD, Robbins KK, Cam EL, Garbuzov A, Miyakawa-Liu M, Goodwin B, Malik I, Tholen C, Green M, Archie S, Tucker T, Ebberman M, Denton GD PMID: 32612467 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Medical Student Mobilization During a Pandemic: The Ochsner Clinical School Response to COVID-19.
Authors: Ayoub P, Chang DD, Hussein N, Stewart K, Wise A, Malik I, Robbins K, Savage B, Johnson M, Shah S PMID: 32612468 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

In Vitro Lymphocyte Functions in Undernourished Children With Sickle Cell Anemia.
Authors: Kuvibidila SR, Gardner R, Velez MC, Yu L, Warrier RP Abstract Background: Children with sickle cell disease (SCD) often suffer from growth deficits and impaired immunity. However, the association between mild to moderate malnutrition and in vitro lymphocyte function has not been well studied. The goal of this study was to investigate the effects of undernutrition on lymphocyte functions in children with SCD. Methods: Weight; height; plasma concentrations of albumin (Alb), prealbumin (PA), transferrin (Tf), retinol-binding protein (RBP), α1-acid glycoprotein (AGP), C-reactive protein (CRP), and cerulo...
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients.
This study assessed low-acuity emergency department (ED) patients' ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED. Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes. Results: Health literacy (r=0.114, P=0.023) and self...
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Variability of Paranasal Sinus Pneumatization in the Absence of Sinus Disease.
Conclusion: Substantial anatomic variation exists in paranasal sinus anatomy, even among patients without sinus disease. Significant differences are found between males and females and between the left and right sides. Continued systematic research of paranasal sinus anatomy may facilitate a standard for CT sinus assessment that will aid clinician evaluation of anatomic variation and surgical decision making. PMID: 32612471 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

The Modified Early Warning Score as a Predictive Tool During Unplanned Surgical Intensive Care Unit Admission.
Authors: Kumar A, Ghabra H, Winterbottom F, Townsend M, Boysen P, Nossaman BD Abstract Background: The Modified Early Warning Score (MEWS) has been proposed to warn healthcare providers of potentially serious adverse events. We evaluated this scoring system during unplanned escalation of care in hospitalized surgical patients during a 1-year period. Methods: Following institutional review board approval, all consecutive, unplanned surgical admissions into the surgical intensive care unit (SICU) during 2016 were entered into this study. MEWS and patient demographics during bedside evaluation for SICU admission were ...
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Gamer's Thrombosis: A Review of Published Reports.
Conclusion: We strongly encourage screening gamers for possible VTEs if clinically warranted. PMID: 32612473 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Hydralazine-Induced Isolated Lupus Nephritis.
Conclusion: Isolated renal disease induced by hydralazine as part of drug-induced lupus is uncommon. Our patient developed isolated classic lupus nephritis after hydralazine therapy with no associated systemic vasculitis. Treatment required stopping the hydralazine and initiating systemic immunosuppressive therapy to achieve complete remission. PMID: 32612474 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Hyperbaric Oxygen Treatment of Keratitis Following Facial Hyaluronic Acid Injection.
Conclusion: Using HBOT to successfully treat ocular ischemia has been reported, but to our knowledge, our case is the first report of successful HBOT use for ocular ischemia and keratitis following cosmetic facial HA injection. PMID: 32612475 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Cholangiocarcinoma Metastasis to the Spine and Cranium.
Conclusion: To our knowledge, only 6 cases of cranial CCC have been reported, and only 2 reported mixed cranial/spinal involvement. We report a rare case of CCC metastasis to the spine and cranium that was treated with surgery, chemotherapy, and radiotherapy. CCC should be considered an exceedingly rare etiology with treatment options aimed solely at palliation. This case supplements the existing literature to inform medical and surgical decision-making. PMID: 32612476 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

A Rare Case of Bruck Syndrome Type 2 in Siblings With Broad Phenotypic Variability.
Conclusion: The dramatic difference between the phenotypes of these 2 cases is significant because it is the largest known variability of phenotypic presentation in siblings. Previous cases of siblings with differing presentations at birth have been reported, but the extent of these differences is not as extreme as in our cases. Because Bruck syndrome presents similarly to osteogenesis imperfecta and could be clinically mistaken for a form of osteogenesis imperfecta if contractures are minimal, a reasonable focus for research efforts is the development of genetic diagnostic protocols for osteogenesis imperfecta with the go...
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Left Atrial Posterior Wall Thrombus After Posterior Wall Ablation.
Conclusion: To our knowledge, this case is the second report of a left atrial posterior wall thrombus in this setting. The patient's complex and specific set of risk factors likely led to this rare finding. Although left atrial posterior wall thrombus after ablation is rare, in patients with specific risks or a combination of factors that could lead to such a clot, visualizing the left atrium in these patients may be beneficial to minimize the risk of systemic embolization. PMID: 32612478 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Isolated Volar Dislocation of the Fifth Carpometacarpal Joint.
Conclusion: Solitary dislocations of any CMC joint are less common than simultaneous dislocation of multiple CMC joints, especially at the fifth CMC joint with volar dislocation. Because of the potential long-term adverse effects of untreated dislocations, these injuries must not be overlooked. Thus, patients presenting to the emergency department after traumatic injury involving an axial loading force to the hand should be carefully evaluated. PMID: 32612479 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Pneumococcal Meningitis Complicated by Spinal Cord Dysfunction and Acute Polyradiculopathy.
Conclusion: Our case demonstrates the development of spinal cord dysfunction (supported by the sudden onset of paraplegia and the presence of a sensory level) and polyradiculopathy (flaccid paralysis, ascending weakness, and absence of response in neurophysiologic studies suggesting severe damage to the peripheral nerves). The appearance of either complication is unusual, and the simultaneous occurrence of both complications is even more uncommon. PMID: 32612480 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Pyriform Sinus Tract Injury After Traumatic Intubation With Resulting Tension Pneumothorax.
Conclusion: Tension pneumothorax is a rare but reported complication that can occur during intubation and intraoperatively. Early recognition of hypopharyngeal perforation is crucial to successful management. Anticipation of a difficult airway can suggest the use of alternative methods of intubation that may reduce the risk of hypopharyngeal perforation. PMID: 32612481 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Pleomorphic Xanthoastrocytoma of the Pineal Region in a Pediatric Patient With Neurofibromatosis Type 1.
Conclusion: To our knowledge, this case is the fifth report of pineal PXA and the first associated with NF1. Because PXA presents similarly to other NF1-related intracranial tumors, careful diagnosis via immunohistochemistry is imperative. Gross tumor resection is usually curative; however, PXA has the propensity to undergo malignant degeneration and may require adjuvant treatment. PMID: 32612482 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Pulmonary Adenocarcinoma Presenting as a Pineal Gland Mass With Obstructive Hydrocephalus.
Conclusion: The pineal region is an unusual site for brain metastasis. Although such metastasis has rarely been described, it should be considered in the differential diagnosis of pineal region tumors, especially for patients with suggestive clinical or histopathologic features of primary malignancy elsewhere. PMID: 32612483 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Gastrointestinal Stromal Tumor: GIST Another Duodenal Ulcer.
Conclusion: Initial EGD and CT findings could have easily been attributed to duodenal peptic ulcer disease for which follow-up endoscopy is not routinely recommended given the low risk of malignancy. However, because of the high index of suspicion on the part of the referring physicians, duodenal GIST was diagnosed. This case extends the spectrum of the presentation, evaluation, and diagnosis of GISTs and stresses the importance of keeping this rare disease on the provider's differential, even after routine workup shows no findings of tumor. PMID: 32612484 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt.
Conclusion: Few case reports detail the appropriate anesthetic considerations for cases of VPS migration. This report describes shunt migration pathophysiology and patient assessment with a focus on anesthetic preparation and management for this rare complication. PMID: 32612485 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 4, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Human Subjects Protection in the Era of the Revised Common Rule.
Authors: Breault GEJL, Bazzano L PMID: 32284673 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Update on the Risks of Electronic Cigarettes-Vaping.
Authors: Reasoner JJ, Regier BA, Beckendorf R, McAllister RK PMID: 32284674 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

E-Cigarette- or Vaping-Associated Lung Injury: An Unprecedented Enigma.
Authors: Hussain AA, Sarwar R, Tahir A PMID: 32284675 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Stroke-Like Migraine Attacks After Radiation Therapy Syndrome.
Authors: April D, Lall N, Steven A PMID: 32284676 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Managing What You Can't Measure-Institutional Review Board Decision Support Software.
Authors: Rosenfeld SJ PMID: 32284677 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Community Member's Perspective: Serving on an Institutional Review Board.
Authors: Butcher BT PMID: 32284678 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Why Human Subjects Research Protection Is Important.
Conclusion: The examples from history and the scarcity of contemporary examples demonstrate that the regulations for the protection of humans participating in research have evolved in a way that minimizes the probability that subjects will be harmed when they choose to participate in research. The examples also reinforce the importance of individual responsibility. Failure of IRBs to provide appropriate review and oversight can lead to severe consequences, as can abrogation by the investigator to place the well-being of the subjects as the primary responsibility in any research protocol. Understanding how we arrived at the...
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Vulnerability in Research: Basic Ethical Concepts and General Approach to Review.
Conclusion: Although vulnerability is often presented as a yes/no consequence related to some characteristic of a group, a more accurate approach is to consider vulnerability as occurring along a spectrum of seriousness and as a consequence of situations and context. With this idea in mind, investigators and IRBs are advised to take a stepwise approach to determining if the study meets the regulatory and ethical admonition to ensure that safeguards protect the rights and welfare of vulnerable subjects. PMID: 32284680 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Research in Pregnant Subjects: Increasingly Important, but Challenging.
Conclusion: While recognition of the need for more scientific knowledge on the effects of medications and other interventions in pregnancy is widespread, a number of barriers that hinder enrollment of pregnant women in clinical trials remain. PMID: 32284681 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Investigator Responsibilities in Clinical Research.
Conclusion: Investigators are not only responsible for producing high-quality, meaningful, scientific research, but they are also responsible for maintaining public trust. If the principal investigator acts with integrity and provides training and oversight of employees, FDA inquiries should go smoothly. Following good clinical practice standards for clinical research will result in quality data collection and facilitate the analysis and publication process. PMID: 32284682 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Institutional Review Board Assessment-Balancing Efficiency and Quality.
Conclusion: Ongoing quality assessment and continuous improvement in decision-making are likely to require committed resources, but such a commitment will be necessary to provide balance to the impetus to improve efficiency and administrative performance. PMID: 32284683 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

How to Determine if a Project Is Human Subjects Research, a Quality Improvement Project, or Both.
Conclusion: In most instances, the goals of human subjects research and quality improvement projects do not intersect, and quality improvement projects are generally not subject to US Department of Health and Human Services (HHS) regulatory protections. However, some projects are both quality improvement and human subjects research, and sometimes, a quality improvement project develops into a human subjects research project. Investigators must be aware of the criteria defining human subjects research to ensure that HHS regulations for the protection of human subjects are applied when necessary. PMID: 32284684 [PubMed] ...
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Revised Common Rule Changes to the Consent Process and Consent Form.
Conclusion: The revisions to the Common Rule are intended to enhance human subject protection by providing more information in an understandable form during the consent process. The new consent elements aim to increase transparency and help improve clarity. PMID: 32284685 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Implementation of Common Rule Changes to the Informed Consent Form: A Research Staff and Institutional Review Board Collaboration.
Conclusion: Research coordinators play an essential role in developing consent forms and providing the required review information to the IRB. In turn, through optimizing and standardizing consent forms and ensuring that all requirements of the Common Rule are followed, IRBs ensure that the rights of participants are protected and upheld. PMID: 32284686 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Understanding Broad Consent.
Conclusion: Broad consent provides flexibility that did not exist prior to the revision, giving researchers the option to obtain broad consent for the storage, maintenance, and secondary research use of identifiable private information or identifiable biospecimens. With an understanding of the regulations, an investigator can plan how best to organize his or her research plan and decide whether to obtain study-specific informed consent, to apply for a waiver of consent, or to obtain broad consent. PMID: 32284687 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Exemptions and Limited Institutional Review Board Review: A Practical Look at the 2018 Common Rule Requirements for Exempt Research.
Conclusion: Whether the revised regulations will meet the needs of the research community and human subject participants is unknown. While the revised Common Rule includes some welcome modifications and additions, the changes have also introduced new concepts that are not fully elucidated and have therefore introduced new ambiguities. PMID: 32284688 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Important Considerations for the Institutional Review Board When Granting Health Insurance Portability and Accountability Act Authorization Waivers.
Conclusion: Few concrete rules are applicable in the research context that ensure compliance with the HIPAA Privacy Rule. Ultimately, more definitive regulatory guidance integrating HIPAA and the revised Common Rule should be promulgated. PMID: 32284689 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Precision Medicine and the Institutional Review Board: Ethics and the Genome.
Conclusion: In this era of exponentially increasing big data and easy-to-access genetic sequencing data, IRBs will be tasked with adapting their processes and adjusting to the new technology and its corresponding complexities. Such adaptation has always been required of IRBs, but now it will need to occur rapidly as technology and data analysis capabilities accelerate. PMID: 32284690 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Pitfalls and Safeguards in Industry-Funded Research.
Conclusion: Ethically sound actions in physician relationships with industry should be guided by professional standards, medical society guidelines, and local institutional policies. PMID: 32284691 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 16, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

An Ending and a Beginning.
Authors: Amedee RG PMID: 31903049 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - January 7, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Barriers to Conducting Clinical Trials in Developing Countries.
Authors: Khoja A, Kazim F, Ali NA PMID: 31903050 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - January 7, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Survey of Current Management Practices for Carotid Webs.
Conclusion: Familiarity with carotid webs varied across subspecialties. We found some consensus among respondents on the imaging modality preferred to identify webs, on asymptomatic carotid web management, and on recurrently symptomatic (multiple strokes) carotid web management. Less consistency was seen regarding preferences for confirmatory imaging and management of acutely symptomatic (initial stroke) carotid webs. PMID: 31903051 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - January 7, 2020 Category: General Medicine Tags: Ochsner J Source Type: research

Impact of Low-Dose Computed Tomography on Computed Tomography Orders and Scan Length.
Authors: Simmons C, Milburn J Abstract Background: New techniques have reduced the radiation dose delivered from a computed tomography (CT) examination. These techniques do not affect the number of scans ordered, the number of phases in each examination, or the scan length, as these parameters are controlled by ordering providers and CT technologists. The purpose of this study was to determine if deploying low-dose CT resulted in an increase in radiation exposure because of more liberal ordering habits or more liberal scanning ranges. Methods: We identified the most frequent CT examination types through a retrospec...
Source: Ochsner Journal - January 7, 2020 Category: General Medicine Tags: Ochsner J Source Type: research